From the Guidelines
Reactive cellular changes on Pap smears should be managed with a repeat Pap smear within 3 months, and underlying infections should be treated before the repeat test, as recommended by the 1993 guidelines from the Centers for Disease Control and Prevention 1. The management approach is based on the understanding that reactive cellular changes are often a result of inflammation or infection, which can be transient and benign.
- Key considerations in managing reactive cellular changes include:
- Identifying and treating any underlying infections before repeating the Pap smear
- Advising the patient to return for a follow-up Pap smear within the recommended timeframe
- Recognizing that severe inflammation with reactive cellular changes may necessitate a more prompt follow-up, as suggested by the guidelines 1
- The rationale behind treating underlying infections before the repeat Pap smear is to reduce the likelihood of persistent reactive changes due to ongoing inflammation or infection, thus providing a clearer picture of the cervical epithelium's status during the follow-up test.
- It is essential to note that the guidelines from 1993 1 emphasize the importance of follow-up and treatment of underlying conditions, which remains a crucial aspect of managing reactive cellular changes on Pap smears, prioritizing the reduction of morbidity and improvement of quality of life for the patient.
From the Research
Reactive Cellular Changes on Pap Management
- Reactive cellular changes on Pap smears are often due to inflammatory and reactive processes, as seen in 92% of cases in a study by 2.
- The most common criteria for reactive cell change include an increase in nuclear size, presence of nucleoli, binucleation, cytoplasmic vacuolization, and polychromasia, as defined in a study by 3.
- A prospective study by 4 found that among women with Pap smears showing reactive cellular changes, 30% had cervical dysplasia and 6% had cervical cancer.
Risk of Cervical Dysplasia and Cancer
- A cohort study by 5 found that women with reactive cellular changes on their cervical smear face an increased risk of developing high-grade cervical intraepithelial neoplasia (CIN2-3), but not cancer.
- The study by 5 showed that the probability of CIN2-3 was increased in the reactive cellular changes group compared to the group with a normal smear (0.7% versus 0.5%, p=0.002).
- Another study by 6 found that moderate or severe inflammation and aerobic vaginitis were more common in women with major cervical abnormalities, but no significant association was found between deviations of the vaginal milieu and high-risk HPV infection.